COMMON EYE PROBLEMS

TNB Integrated Learning Solutions Bangi, 7th July 2012

Dr. Ahmad Fauzi Md. Sharif Pakar Bedah Mata Hospital Pakar KPJ Klang

No. 102, Persiaran Rajawali/KU 1, Bandar Baru Klang, 41150, Selangor Darul Ehsan

The Red Eye

PAIN? YES? NO? VISION? NORMAL? REDUCED?

DISCHARGE
Patients with pain +/- blurring of vision is likely to have a sight-threatening conditions. The most important differential diagnosis are: ACUTE GLAUCOMA CORNEAL INFECTIONS IRITIS Patient without pain are likely to have a self-limiting conditions, the most common are: CONJUNCTIVITIS EPISCLERITIS SUBCONJUNCTIVAL HAEMMORHAGE

LOSS OF VISION
VISUAL LOSS? FIELD LOSS? PROGRESSIVE vs STABLE FLOATERS/FLASHES

SUDDEN vs CHRONIC

DIABETES

TRANSIENT vs PERSISTENT

Patients with sudden, progressive and persistent loss of vision are more likely to be serious.

Patients with progressive,chronic or transient of vision are less likely to be serious.

RETINAL DETACHMENT VASCULAR OCCLUSION VITREOUS HAEMORRHAGE

CATARACT REFRACTIVE ERROR

FLOATERS
SUDDEN or GRADUAL FLASHES?

INCREASING

Patients with gradual, stable floaters with no flashes are less likely to be serious: POSTERIOR VITREOUS DETACHMENT

Patients with sudden, increasing floaters with flashes are more likely to be serious: RETINAL DETACHMENT VITREOUS HAEMORRGHE

SWOLLEN EYELIDS
PAINFUL ACUTE BILATERAL TENDER

MULTIPLE

Patients with unilateral, painful, acute, recurrent swelling may be and infection or malignancy: CHALAZION CELLULITIS MALIGNANT

Patients with bilateral, chronic swelling may be less serious ORBITAL FAT CHALAZION

WATERY EYES
FOREIGN BODY SENSATION AFFECTED BY ENVIRONMENT

BILATERAL

ITCHINESS

Usually are not a serious problem, but irritating: DRY EYE ALLERGIC CONJUNCTIVITIS BLOCKED NLD CONJUNCTIVITIS GLAUCOMA

PAIN/HEADACHE
RED EYE? SUDDEN? AURA? VISION? ON-OFF? UNILATERAL?

Patients with a painful, unilateral, red eye, and reduced vision are more likely to be serious: GLAUCOMA TRAUMA MIGRAINE

Patients with a mild discomfort, bilateral, and reduced vision are less likely to be serious: PRESBYOPIA

GLAUCOMA
a progressive disease of the optic nerve that is usually associated with an increase of the pressure inside the eye

The acute form leads to severe unilateral eye pain and redness with reduced vision!

GLAUCOMA
Most common form of glaucoma will cause a patient to slowly lose their vision, starting with their peripheral vision. This form is usually painless!

Some of the most common risk factors include; Over age 40 People with a family history of glaucoma Patients with diabetes Patients with history of eye trauma Patients who are Myopic Chronic used of steroids

BACK

CORNEAL INFECTIONS

Visual threatening condition. Usually trauma related. Contact lens wearer

Requires intensive antibiotic treatment. Scarring very likely.

If unsure: DO NOT use STEROID eyedrops or ointment. BACK

CONJUNCTIVITIS

Usually a self limiting condition. May be Bacterial, Viral, Allergic. A bilateral condition. A history of contact. A history of allergy

If after receiving treatment for a few days, and the condition has not resolvedrefer

Subconjunctival haemorraghe: No pain and visual loss May be traumatic or spontaneous May be related to HPT or change in atmospheric pressure Self limiting about 2 weeks

BACK

VITREOUS HAEMORRHAGE
Bleeding into the vitreous cavity Usually sudden in onset. May appear as Floaters or may Completely blind the patient Main cause is Diabetic Retinopathy.

May be self limiting but usually requires surgical removal

Other causes: Trauma Vein Occlusion

BACK

CATARACTS
Pterygium (Selaput Luar)

Causes: Aging Diabetes Trauma Congenital

CATARACTS
Blurring of vision Glare Distortion Colours fade Difficulty driving esp.ly at night Painless No redness Progressive

Requires surgical treatment

BACK

RETINAL DETACHMENT

Retinal detachment is serious vision threatening condition. It occurs when the retinal layer (which is the nervous layer of the eye) becomes detached. This usually occurs due to a break in the retinal layer or due contraction of a fibrovascular tissue Patients will usually notice flashes followed by a sudden increase in floaters.

Requires surgical treatment ASAP.

BACK

POSTERIOR VITREOUS DETACHMENT

The vitreous is a clear substance within the eye, which has a gel-like consistency.

Most people will have a posterior vitreous detachment by 70 years of age and many will develop this change sooner A history of cataract surgery Nearsightedness Inflammation inside the eye Injury to the eye (such as blunt trauma, accident, or falls) Bleeding inside the eye

vitreous gel is composed of 99% water, and the other 1% consists of special substances known as collagen and hyaluronic acid,

BACK

CHALAZION
A chalazion is a lump that occurs due to long-term inflammation and infection of the meibomian (oilproducing) gland and becomes visible on the outer eyelid. May be treated with topical and systemic antibiotics If persistent or recurrent, would need surgical removal

Orbital Fat: Age related Bilateral

Cellulitis: Inflamed Painful Fever BACK

DRY EYES
Presents as Watery eyes

Foreign body sensation Sandy Burning Frequently has to close eyes

Dry weather Haze Windy Aircondition Age related Systemic condition

Blocked NLD

May be mild or severe is Dacryocystitis

Syringing

BACK

MIGRAINE
NOT an eye problem! Has eye symptoms: Zig-zig scotoma Photophobia Eye pain: not in the eye Headaches Nausea and vomitting

Many types: Common Classical Ophthalmic

TERIMA KASIH

fauzi@kpjklang.com